EAACI Allergen Immunotherapy User's Guide

Montserrat Alvaro-Lozano; Cezmi A Akdis; Mubeccel Akdis; Cherry Alviani; Elisabeth Angier; Stefania Arasi; Lisa Arzt-Gradwohl; Domingo Barber; Raphaëlle Bazire; Ozlem Cavkaytar; Pasquale Comberiati; Stephanie Dramburg; Stephen R Durham; Aarif O Eifan; Leandra Forchert; Susanne Halken; Max Kirtland; Umut C Kucuksezer; Janice A Layhadi; Paolo Maria Matricardi; Antonella Muraro; Cevdet Ozdemir; Giovanni Battista Pajno; Oliver Pfaar; Ekaterina Potapova; Carmen Riggioni; Graham Roberts; Pablo Rodríguez Del Río; Mohamed H Shamji; Gunter J Sturm; Marta Vazquez-Ortiz

doi:10.1111/pai.13189

EAACI Allergen Immunotherapy User's Guide

Pediatr Allergy Immunol. 2020 May;31 Suppl 25(Suppl 25):1-101. doi: 10.1111/pai.13189.

Authors

Montserrat Alvaro-Lozano¹, Cezmi A Akdis^{2

3}, Mubeccel Akdis², Cherry Alviani^{4

5

6}, Elisabeth Angier⁷, Stefania Arasi⁸, Lisa Arzt-Gradwohl⁹, Domingo Barber^{10

11}, Raphaëlle Bazire¹², Ozlem Cavkaytar¹³, Pasquale Comberiati^{14

15}, Stephanie Dramburg¹⁶, Stephen R Durham^{17

18}, Aarif O Eifan¹⁹, Leandra Forchert¹⁶, Susanne Halken²⁰, Max Kirtland²¹, Umut C Kucuksezer²², Janice A Layhadi^{17

18

21}, Paolo Maria Matricardi¹⁶, Antonella Muraro²³, Cevdet Ozdemir^{24

25}, Giovanni Battista Pajno²⁶, Oliver Pfaar²⁷, Ekaterina Potapova¹⁶, Carmen Riggioni²⁸, Graham Roberts^{4

29

30}, Pablo Rodríguez Del Río¹², Mohamed H Shamji^{17

18}, Gunter J Sturm⁹, Marta Vazquez-Ortiz³¹

Affiliations

¹ Pediatric Allergy and Clinical Immunology Service, Hospital Sant Joan de Déu, Barcelona, Spain.
² Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
³ Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
⁴ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
⁵ Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Primary Care and Population Sciences, University of Southampton, Southampton, UK.
⁸ Pediatric Allergology Unit, Department of Pediatric Medicine, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy.
⁹ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
¹⁰ School of Medicine, Institute for Applied Molecular Medicine (IMMA), Universidad CEU San Pablo, Madrid, Spain.
¹¹ RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III, Madrid, Spain.
¹² Allergy Department, Hospital Infantil Niño Jesús, ARADyAL RD16/0006/0026, Madrid, Spain.
¹³ Department of Paediatric Allergy and Immunology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
¹⁴ Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁵ Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy.
¹⁶ Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany.
¹⁷ Immunomodulation and Tolerance Group; Allergy and Clinical Immunology, Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK.
¹⁸ the MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
¹⁹ Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospitals NHS Foundation Trust, London, UK.
²⁰ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
²¹ Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.
²² Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul University, Istanbul, Turkey.
²³ The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Women and Child Health, University of Padua, Padua, Italy.
²⁴ Institute of Child Health, Department of Pediatric Basic Sciences, Istanbul University, Istanbul, Turkey.
²⁵ Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Turkey.
²⁶ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
²⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
²⁸ Pediatric Allergy and Clinical Immunology Service, Institut de Reserca Sant Joan de Deú, Barcelona, Spain.
²⁹ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³⁰ Paediatric Allergy and Respiratory Medicine (MP803), Clinical & Experimental Sciences & Human Development in Health Academic Units University of Southampton Faculty of Medicine & University Hospital Southampton, Southampton, UK.
³¹ Department of Paediatrics, Imperial College London, London, UK.

Abstract

Allergen immunotherapy is a cornerstone in the treatment of allergic children. The clinical efficiency relies on a well-defined immunologic mechanism promoting regulatory T cells and downplaying the immune response induced by allergens. Clinical indications have been well documented for respiratory allergy in the presence of rhinitis and/or allergic asthma, to pollens and dust mites. Patients who have had an anaphylactic reaction to hymenoptera venom are also good candidates for allergen immunotherapy. Administration of allergen is currently mostly either by subcutaneous injections or by sublingual administration. Both methods have been extensively studied and have pros and cons. Specifically in children, the choice of the method of administration according to the patient's profile is important. Although allergen immunotherapy is widely used, there is a need for improvement. More particularly, biomarkers for prediction of the success of the treatments are needed. The strength and efficiency of the immune response may also be boosted by the use of better adjuvants. Finally, novel formulations might be more efficient and might improve the patient's adherence to the treatment. This user's guide reviews current knowledge and aims to provide clinical guidance to healthcare professionals taking care of children undergoing allergen immunotherapy.

Keywords: Allergy; immune regulation; immunotherapy; tolerance.

Publication types

Review

MeSH terms

Administration, Sublingual
Adolescent
Allergens / immunology
Animals
Asthma / immunology
Asthma / therapy
Biomarkers / analysis
Child
Child, Preschool
Desensitization, Immunologic / methods*
Desensitization, Immunologic / standards
Health Personnel
Humans
Hypersensitivity / immunology
Hypersensitivity / prevention & control
Hypersensitivity / therapy*
Injections, Subcutaneous
Pediatrics / standards*
Pollen / immunology
Practice Guidelines as Topic*
Pyroglyphidae / immunology
T-Lymphocytes, Regulatory / immunology

Substances

Allergens
Biomarkers